Sourcing House - Government Bodies Account Application

Government Bodies Account Application

Click here to download form in a MS Word Document
* = required fields

Organization Information
Organization Name:
Address1:
Address2:
Post Code:
Phone:
Fax:
E-Mail:
Website:

Organization Description

Employees
5-25		250-500
25-100		500+
100-250

Organization Information (cont)
Date of first Trading:
Type of Organization:
Registered Address:
Director or Partner:
Email Address:

Organization Information (cont)
VAT Number:
Registered Number:

If not a limited or plc organization, please include directors/partners addresses below

Director/Partner 1
Name#1:
Address1:
Address2:
Post Code:
Telephone:
Fax:
Email:

Director/Partner 2
Name#2:
Address1:
Address2:
Post Code:
Telephone:
Fax:
Email:

Credit Information
Required Credit Limit £:
Purchase Ledger Contact:

Purchase Ledger Contact Information
Telephone:
Email Address:

Trade Reference #1
Name:
Address1:
Address2:
Post Code:
Telephone:
Fax:
Email:

Trade Reference #2:
Name:
Address1:
Address2:
Post Code:
Telephone:
Fax:
Email:

Banker Information
Bankers:
Address:
Telephone:

Banker Information (cont)
Account Number :
Sort Code :
Fax:

Discount/Factoring Organization
Do you use a discounting or factoring organization?	Yes No

If so enter Name and Full Address here

Note: You must inform your factoring or invoice discounting organization that we hold retention of title over all goods supplied and any monies received for their purported resale.

Signature
Signed:
Date:

Authorization
Authorized Signatory:
Job Title:
Print Name:

There are no specials available at this time

Manufacturers